Apendicectomia transumbilical videoassistida em crianças e adolescentes : estudo prospectivo no Hospital das Clínicas da UFMG/EBSERH

Abstract

Objective: Appendicitis is a the most common cause of acute abdomen in children and adolescents. Urgent appendectomy performed through minimally invasive techniques offers significant benefits. Transumbilical laparoscopic assisted appendectomy (TULAA) is a technique that combines the advantages of videolaparoscopy with open surgery, by doing an extracorporeal appendiceal resection. This study aims to analyze the profile of children undergoing appendectomy at HC-UFMG, including the surgical access routes, postoperative outcomes, emphasizing the importance of appendectomy to training medical residents in videolaparoscopy. Method: This is a prospective, observational study, based on the medical records of patients who underwent appendectomy at HC-UFMG between September 2021 and August 2024. Collected variables included: demographic data, preoperative clinical characteristics, work up exams, surgical access routes determined by the attending surgeon, classification of appendicitis, and postoperative outcomes. The total volume of pediatric videolaparoscopic procedures performed during this period were also described. Results: A total of 156 patients underwent appendectomy over a three-year period, with 105 (63.7%) being male. The range ages was 2 to 17 years and the average was 9 years. The mean weight was 34.1 kg. The average duration of preoperative symptoms was 3 days (median: 3 days). Approximately 50% of patients presented to the specialist with more than 3 days of symptoms. Diagnostic workup included: complete blood count in 128 patients and C-reactive protein in 118; abdominal ultrasound in 94 (60.3%) patients, and abdominal CT in 20 (12.8%). Regarding surgical access, 131 (84.0%) patients underwent laparoscopic appendectomy and 25 (16.0%) underwent open appendectomy. TULAA was performed in 122 (78.2%) patients: in 50 with two trocars, and in 72 with three. Intraoperative findings confirmed complicated appendicitis in 71 (45.5%) patients. Postoperative complications occurred in only 21 (13.5%) patients, all of them with complicated appendicitis, with 6 (6.3%) requiring reoperation during the same hospitalization. No complications were reported relative to the laparoscopic acess. The average length of hospitalization was 5 days (median: 4 days). The average hospitalization time for children with uncomplicated appendicitis was only 2.2 days, compared to 8.4 days for those with complicated appendicitis. TULAA with two trocars was the technique with the shortest duration, preferred in cases of uncomplicated appendicitis. TULAA with three trocars was successful in 39/71 patients with complicated appendicitis. Patients with complicated appendicitis were more likely to undergo open surgery, had a higher incidence of postoperative complications, and a longer length of stay. Appendectomy accounted for 54% of pediatric videolaparoscopy procedures performed at this hospital during the study period. Conclusion: Clinical management protocols for children and adolescents with acute abdominal pain are essential for improving the efficiency of transferring these patients to the referral pediatric surgical services. TULAA was effective, safe, and rapid in the treatment of uncomplicated appendicitis. Laparoscopic appendectomy is a valuable method for training pediatric surgery and pediatric anesthesiology residents. National multicenter studies with larger cohorts are desirable to validate the findings of this research.